had this surgery done last June and the nerve pain was gone immediately post surgery. before surgery, i was experiencing increasing nerve pain down my leg. made decision to skip PT and shots when i started losing muscular strength and function in my foot. that was kind of freaky.

once the totally rest and rehab phase was over (6 weeks) i started getting back into swimming and cycling. was running again in mid-September and full bore training again in mid October for a November half-ironman race. i don't know if i was REALLY lucky and just had a successful surgery (thanks Dr. Zubay -- a stud triathlete here in Texas) but i took the initial 6 weeks of recovery VERY seriously. taking the dogs out for a walk around the neighborhood was the only 'exercise' i allowed for myself.

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Lars Finanger
Odyssey SwimRun

You are correct that microdiscectomies typically do not address LBP. Nerve compression creates radiculopathy (pain down the leg). MRIs are so sensitive that they show everything going on in the back area, but do not readily identify what is causing the pain. Research regularly demonstrates poor correlation between MRI findings and pain. Given all this, it is possible that surgery resolves pain, but it is also likely pain will be left unresolved. Research also shows surgery for LBP to be effective approximately 50% of the time. The reason for this is poor ability to identify the cause of pain. General surgeries based on supposition do not really turn out well. A conservative approach is more appropriate without true identification of a pain generating structure and how to fix it. Braces are useless as well. I am a physical therapist, and therefore biased, but I do specialize in spine pain and do recommend a McKenzie approach to treating this condition. Research on this approach to treating LBP does support the mechanical evaluation and repeated motions. It is likely you have lost a significant amount of lumbar extension (ability to bend backward) and would benefit from repeated extension and possibly joint mobilizations. Core stabilization will not help, crunches or knee to chest stretching is likely to worsen the condition. In addition, back pain is generally episodic in nature and tends to self-resolve within 6 months to a year as long as you are not perpetually making it worse on a day-to-day basis. All of this info is readily available on the internet. Look it up and find a different PT to treat you and make you better.

Hi, I really appreciate your input and I thank you for your recommendations, it is really a hard decision as to what way to go forward, but since last July when this happened with my back I have tried lots of physical therapy with a really good therapist who specialized in the back, I have continued to do the exercises at home, I even tried a chiropractor but I didn’t feel any relief from that at all. None of the exercises even the McKenzie exercises I do every day really have helped with the pain reduction they have helped me get stronger back muscles and more limber for sure. I do have good range of motion with my back as I have continued to bend back and to the sides as much as possible, even purchased a teeter totter to help decompress the spine hanging upside down.

The two epidurals didn’t do anything so I see no reason to do the third I figured. But what worries me the most is the nerve radiating pain in the groin and down the leg has diminished a lot over the past month or so but I am now left with excruciating low back pain which I have tried to help relieve with my tens unit, massage machine, hot and cold packs even have some strong lidocanie and anti-inflammatory gel that my wife massages into my back a couple of times a day and nothing helps. So that is why I am concerned and trying to learn as much about surgery before going through with it even though two MRI scans show the 4 to 6 mm bulge right where the major pain is on the left side at L3/L4 disk area. I realize at the end of the day the choice is mine but I do want to feel as close to 100% as I can going into the surgery room but right now I am still about 50% believing perhaps for some miracle to happen. Thanks again for your input. LA Rob

I am a neurosurgeon working and living in Long island, NY... and deal with these quite frequently.

I am happy to speak with you off-line if you like.

PM if you want to chat...

That is very kind doctor I would love to but I am not sure how to pm you as there is no e mail listed under your site name.

Figured it out as it had been a while, I have sent you a PM

Thanks Rob

If you do decide to have surgery see the thread I started on coming back from discectomy surgery. Might answer some questions for you.

Thanks I will check it out, I do have to ask did you have lots of nerve pain or mainly bad back pain before the surgery, as it seems my nerve pain has diminished a lot now it is just my back which is incredible sore, but I am still able to do stretches but since the back pain came on just before the holidays I have not felt nor done any other exercises as it just feels too sore, but leading up to the holidays when it was just the nerve pain I was able to ride and swim and go to the gym etc. even did a few little one mile runs and it didn't seem to bother the back too much.

I am concerned as from what I have read the discectomy doesn't really help just back pain but more the nerve pain? Thanks LA Rob

Mine came on very suddenly. I had just had my last long hard weekend of workouts 3 weeks before IM Boulder and until then didn't have any pain or numbness. I woke up in the middle of the night and couldn't get comfortable. Over the next 3 days the pain and numbness down my left leg grew exponentially to the point where I couldn't walk more than about 20 steps due to the pain in my left quad. Left quad had a lot of pain and rest of leg was numb. On Wednesday I ended up falling down because my leg just gave out. By Friday that week I had seen my regular dr, then emergency room dr, then neurologist and then surgeon. By the time I has surgery that Sunday, yes Sunday, I could barely move anymore. Had to use a cane to get around due to pain in left leg. My issue was a ruptured disc in l4/5. The interesting thing is I have never at any point in all this had any pain or numbness in my back. Always been in my left leg.

Wow that is amazing how quickly it got so debilitating, as when mine started back in July it was terrible back pain for about a week then that seemed to ease then it just went to nerve pain in my groin and down the leg, but now of course it is now back to just the back pain. The bloody back is something it is hard to know what do but of course in your case it was so needed glad that was able to solve the problem and you are now able to get back to it. Thanks for the insight and in puts. Cheers LA Rob

How was your improvement and recovery post surgery?

Go to my profile. On the bottom left side is a button that says "show users posts". Hit that and find my thread on "Coming back from discectomy/laminectony". I go through my recovery from the start until 4 months out.

hercules wrote:

Wow that is amazing how quickly it got so debilitating, as when mine started back in July it was terrible back pain for about a week then that seemed to ease then it just went to nerve pain in my groin and down the leg, but now of course it is now back to just the back pain. The bloody back is something it is hard to know what do but of course in your case it was so needed glad that was able to solve the problem and you are now able to get back to it. Thanks for the insight and in puts. Cheers LA Rob

Not from my experience but from some research I have had recently on this topic:

1. If I got you right, you said you had pain in both the back and the groin and now you have it only in your back. This is called "pain centralization" (from a limb to back) and is, in general, a sign of improvement and good prognosis.

2. Even if the MRI image shows that the herniated disc is pressing on the nerve, even a doctor can't say for sure if it really does. MRI images, herniation size and pain typically do not correlate well. The pain that causes pain only in the lower back is called "discogenic pain" (arising from the damaged disc itself), as opposed to "radicular pain" from a pinched nerve root. As you mentioned, surgery is much less effective if you have only lower back pain (probably discogenic pain) compared to pain in a leg.

3. Herniated disc can heal on its own in most cases without any therapy at all, even without physiotherapy. According to few systematic reviews, 2 years after onset of pain, most individuals included in studies had about the same pain improvement no mater what type of treatment they had.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/

4. Steroid injections may relieve pain temporarily but they probably do not speed up recovery or really treat anything.

5. A very important aspect of disc healing is that you allow it to "rest." Try to avoid anything what triggers pain, mainly bending, sitting, **driving** (vibrating pain can be very harmful for a disc), lifting heavy objects and any heavy physical work or exercise. Walking is, in general, recommended, even light running.

6. Another source of your pain may be a reflexive tightness of the muscles along your lumbar spine. It's called myofascial pain (especially if you have muscle knots). Injections into muscle knots may help, but I'm not trying to recommend them here, because there is not enough reliable data about their effectiveness. You may find other ways to relax your lower back muscles - a good physiotherapist could tell what to do.

Use your intuition, avoid pain triggers, think about your body positions, do not try to get rid of pain in order to be able to train heavy again, but in order to live and do your work.

I very strongly recommend you to take your time and not rush into the surgery.

This. I was diagnosed with a L1-S5 herniated disc, and had terrible pain. Couldn't put on my own socks, could barely get out of bed. It got slightly better, did physical therapy, and that didn't help (in fact, I think I back tracked a bit). Then I did the shots as well, and I struggled. Three separate doctors told me to get the surgery, but I waited (because, quite frankly, I was scared).

And a strange thing happened, it started to get better. I continued my stretches every day, and make smart decisions about things (sorry friend, can't help you move this weekend). I went through two full seasons now, mostly pain free. It flairs up here and there, but I'm smart about resting when pain comes up.

Perhaps I got super lucky, I don't know. Good luck, and I hope you are pain free soon.

Thank you so much for your insight and comments truly appreciated, I guess I am over the shock of being told by the doctor this past Tuesday I need to have surgery to get rid of the pain or else it will only get worse. I am going to cancel the surgery being scheduled for the end of January and continue on doing the physical therapy and such in the hope the pain in the low back will diminish, I feel lucky as 95% of the time now the nerve pain is gone, so hopefully something is working and the body is healing. It is quite shocking really I suppose you go through life very fit and then get hit by terrible low back and nerve pain like what happened to me last July after a bike ride no doubt it wasn't just that one ride though as it probably had been building and just waiting to happen. But I will attest for anyone who has never suffered low back and nerve pain it is brutal and so life changing, not a day goes by where you feel good all you want to do it keep on trying anything to help remove the pain, but like most things I guess the biggest healer is time. Cheers LA Rob

I'm in a very similar situation, only for me it is my L5/S1 disc that has herniated. I've spent the last two years and three months dealing with this off and on, finally had my third MRI and the doctor finally said I was a good candidate for surgery! After dealing with this for so long, I thought I would be happy for surgery, but like you I've started second guessing that decision. My L4/L5 is also degenerated along with the L5/S1, plus doc says I have arthritis in my lumbar. Says I might need back fused in the future... So, now I'm thinking maybe the herniation will be absorbed and avoid surgery as long as possible! Frustrating to have gone from being someone who raced 40 or so times a year to not racing the past couple of years... Going to do some searching for a PT in the area who does McKenzie work, maybe find some yoga for back health classes as well...

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Tony
http://www.triathleteguru.com

I had a herniated L4/L5 back about 15 years ago. My symptoms fit perfectly with my MRI results (the surgeon predicted the scan results before it was done). I tried to delay surgery with steroids and therapy but when my foot went numb I knew it was time. The moment I woke up in recovery I knew it had worked. The radical are pain was gone, replaced by surgical pain that got better over the course of a couple of weeks. It's been great ever since.

Interestingly, my two childhood best friends were dealing with back pain around the same time. Both had herniated disks on MRI but their symptoms were not clearly corresponding to the MRI findings. Both had surgery and neither got better.

Now n=3 isn't definitive evidence but I think it illustrates the point: if your symptoms are radicular (pain coursing along that nerve's territory where the herniation is pushing) surgery has a good chance of helping. If the pain doesn't match, I'd not be in any rush for surgery.

Look up dermatome on google images and it'll show you the territory covered by each nerve level. Look at L3 and see if that's where you're hurting, but from your description it doesn't sound like that's your symptom.

I second the McKenzie approach, and I am also biased as I am a Physical Therapist. Find a McKenzie therapist, not a spine PT, there is a difference.... they will have the knowledge to treat the lateral bulge before the posterior which should give you the result you are looking for.

Great to see your post Lars. I just had to cancel my Orcas registration for this year as I had a discectomy this week on my L5/S1. Great to see there are others that had great results. I am 4 days out of surgery with zero pain and doing everything EXACTLY as prescribed by my surgeon. They key, as you said, is to take it very easy. No matter how good you may feel don't be fooled. You have a long healing process ahead. If you committed to surgery then you have to equally commit to the process afterwards if you want to get back anywhere near to normal activities. It's really hard staying still but for me, walking for the next 6 weeks is all that is on my agenda until told otherwise. Results definitely can and do vary for the procedure and you should do all that you can insofar as non-surgical treatments before making a decision. My herniation was 3x the size of the guy that started this thread. A lot of the failed procedures have a reason; weight, returning to activity too soon, failing to comply with post-op procedures, and of course, medical and physiological reasons as well - there are no guarantees. How you treat your post-op rehab will be a big determinant of your success.

In a similar situation; how did this end up for you.

I have been doing 8 weeks and contemplating surgery.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz